Aa
Aa
A
A
A
Close
Avatar universal

my Symfony IOL Results

I just had Cataract Surgery with a Symfony IOL and kept some notes before and after surgery.   This site has been very helpful to me while doing my research and wanted to contribute.   Very special thanks to softwaredeveloper & Dr. Hagan for all their contributions.   This is a bit long, but hopefully helps someone in a similar situation.  

About Me
Male - Age 50
Contact lens RX: -2.0 in each eye
IOL implanted:      Symfony   +15.5D SE     0r: 13mm  0b: 6mm
Reading Glasses (when wearing contacts):  +1.5 - 1.75 magnification
Astigmatism: Very slight- no special lens or procedure required to adjust for it.

Background: I was first diagnosed a couple of years ago when vision appeared a bit blurry some of the time.  I've been putting off getting this surgery in hopes better lenses would become available.  

Lifestyle:  I'm very active.   Engage regularly in sports like tennis, golf, mountain biking, etc.  

Concerns: Being younger and male there's an increased chance for Retinal Detachment- very concerned about this.    Some minor concerns: I can read fine w/o contact lenses - How will this impact the daily work I do using a computer?  How will it affect my eye-hand coordination for sports.   Will intermediate/near vision be degraded and impact hobbies like reading sheet music / playing guitar?  

4 months before surgery (routine eye exam):
- doctor said cataract in one eye was still considered mild and other eye had a very slight cataract, but was not impacting my field of vision at this time
- performed an eye test (wearing contact lenses) in a dark room with a lighted chart and vision was 20/30 in bad eye.
- he then illuminated a light behind the chart (shining towards me) and I was unable to read the chart at all with my bad eye- my good eye saw it no problem.
- he said under optimal lighting conditions my vision is technically fine, but certain conditions (sunny days, lights shining towards me, etc. ) will reduce it to 20/100 or worse in the bad eye
- he discussed cataract surgery and suggested a monofocal lens set for distance

2 months before surgery  consultation with doctor
- asked about Symfony lenses as they were recently approved at that time.
- he had limited experience with symfony and said they appear good, but could have similar visual disturbances as multi-focal lenses
- he again suggested monofocal to reduce side effects as well as cost (free with insurance), but said intermediate and near vision would not be very good  and would definitely require readers.


1 month before surgery - pre-op exam & measurements
- several tests were conducted to obtain measurements- the whole process took about an hour
- After the measurements I consulted again with the doctor.  The first thing he said to me was in the time that he had last seen me, he had performed several implantations of symfony lenses.   He said results were very encouraging and that this new lens could become his practice's  premium lens of choice.  I decided to move ahead with the symfony at a cost of $2700 out of pocket per eye.  He said I did not have to do both eyes now, but having the same lens in both eye would make neuro-adaptation easier and vision better.
- He offered laser assisted surgery for removal of natural lens.  Price was $1000 more and said  refractive outcome was the same if I did laser assisted or standard phacoemulsification.  He said laser is 'possibly' less traumatic on the eye.  He didn't pressure one way or the other and said think about it and let us know a few days before what you decide.   I decided on the traditional non-laser approach.

Day of Surgery
- Arrived at surgical center 6:00AM and was finished and on my way home by 8:00AM
- was partially awake during procedure - no pain - just one point I felt a slight poke
- 11:30AM removed bandage and everything appeared cloudy-  I was expecting a better visual response, but even through the cloudiness I was able to read a digital clock from about 15 feet so I knew the distance vision was improved
- 1:00PM cloudiness is clearing up, but unsettling visual disturbance- everything out of the corrected eye is tilted at about 20 degrees off center.  Very disturbing and creating motion sickness type feelings.  As I move my head from side to side the angle changes- I assume the lens was not placed  properly.  I call the surgeon and he responds that it will improve as local anesthetic wears off.  Sure enough by about 3PM both eyes were in-synch, but some cloudiness remained
- Other visual disturbance was two VERY large and distinct halos around all lights. This concerned me since a possible side effect of multifocal lenses are halos.   Looking outside was overwhelming as every car, street, house light all projected two very distinct concentric halos.  
- End of day - most of the cloudiness in vision has dissipated, but still exists in periphery  

One day post-op
- woke up and much less cloudiness in vision. when looking at lights only one halo now instead of two and the one halo looked smaller than previous day.   Pupil still dilated - and hoping this is a result of that and not so much the symfony lens
- intermediate vision is improved I can read my computer monitor and iPhone from about arms length, not perfect but better than my other eye.   Was able to read dashboard digital display on my car without issue.  So hopes are high this will get better over upcoming days/weeks.
- Near vision (within 12") is no different (maybe worse) than my unoperated eye at this time
- 3:00PM Halos are gone
- 4:00PM MD visit - he said eye is looking good & vision is better than expected at this point. Not perfect yet, but he expects 20/20 or better for distance and very good intermediate.  Near vision he didn't project an outcome at this time.
-  Nighttime driving on the freeway - some of the overhead street lights flared out like fire works as I passed by - very distracting, but thankfully were gone the following night

Two Days Post OP
- Intermediate vision is definitely getting better - I can read my iPhone from about 18 inches.  Some apps are harder to read - anything with white text on green background is a bit harder to see than white on black or black on white.  
- The above is probably related to contrast sensitivity which  is improving.   Colors are looking more colorful and less washed out in my Symfony eye than they did the day before.  Blues and Greens in my symfony eyes looked like pastels compared to my un operated eye, but as days progress colors are becoming more vibrant.

7 days post op
- Vision is excellent.  Distance is better than my good eye with a contact lens and intermediate is also very good.  I can read sheet music fine with just the one eye with the symfony and the other with a contact lens..  iPhone is readable at the smallest font setting (something I couldn't do for years).  I'm able to read menus without issue ( but need some extra light in a dark restaurant)
- very subtle halos around lights at night but  not at all distracting - these are getting less and less visible each day
- overall this has exceeded my expectations

Next Surgery
I have opted not to get the second eye done at this time.  Right now the cataract in that eye is not impacting my vision.   It's a bit of an inconvenience putting in one contact lens each day, but I see clearly and don't want to risk a Retinal Detachment when the eye at this point is clear.

From my research I know some of the risks for RD are:  Males, people in their 50s, long axial length, previous injury, cataract surgery and high myopes.     I'm in my 50s, & male - have not had injury and don't know my axial length (not sure if that can be determined from the IOL specs), but I figured it's not worth the risk at this time.   Doctor said it should not be an issue, but still not comfortable.
12 Responses
Sort by: Helpful Oldest Newest
Avatar universal
Thank you for sharing your complete experience!  I am scheduled to have a Symfony Multifocal Toric implant (no cataracts) next month, and it's comforting to read a positive review, to contrast all the nightmare stories out there.
Helpful - 1
11 Comments
=
cjwinter- good luck with the procedure!

I don't know how old you are, but for me an active 50 year old it has really improved my day to day life.  So far I've only had one eye done and with just that no longer require readers.  I can read my phone at the smallest font, newspapers, restaurant menus (with decent light) or a computer screen without issue.  I also played a set of tennis last night and the ball was easy to pick up on an indoor court under lights.  With two eyes using symfony it would be an even greater improvement.  Right now my dominant eye has symfony and my other eye has no cataract, but a vision correcting -2.00 contact lens.  That eye sees objects slightly smaller than my symfony eye.  I only notice when I cover one eye then the other.  
  
BTW- I also latched onto some of the scarier stories on the internet as well as on this site. Remember - like anything else people are more likely to take time to post in a forum like this if things go wrong.  The vast majority of people with successful outcomes would never post stating that everything was perfect.   That's why I wanted to state my experience.

Just a heads up- there are days where vision fluctuates. These seem like setbacks, but my doc warned me about this.  One day I could read my computer screen and then a few hours later it was a bit blurry and needed readers for an hour or two.   It takes time for the eye to heal and over time should get better and better.   I also believe the many drops you need to put in your eye the first few weeks also contributes to some of this temporary blurriness.  
=
Petey212, since you wear a contact lens on the other eye,  I'd be curious if you'd thought about trying a multifocal contact for the other eye to provide more near. It'd be interesting to hear how someone able to do an extended test thinks that compares to the Symfony.

Once people are old enough to have enough presbyoia to be a probem, they really should be encouraged to try things like multifocal contacts and contacts in monovision before they get a problematic cataract and can't do as accurate a test (even if they usually stick to wearing glasses rather than contacts). There is an extended depth of focus contact lens now approved by the FDA, from the Brien Holden Vision Institute, but I haven't heard about it actually being on the market yet.

I prefer the Symfony to when I wore multifocal contacts prior to surgery,   but I didn't get a chance to compare them head to head (other than for an hour day 1 postop before the other eye was done, when I was still healing and adapting and distracted deciding whether to go ahead with the 2nd eye).
=
SoftwareDev, that's an excellent idea. A couple of years back I tried multifocal contact lenses for a few days.  At first all seemed well but   I didn't love  that I sacrificed some distance vision to get better near.  However, that's when my cataract started in my dominant eye so I already had some distance issues.  At this point it makes sense to give multifocal contacts another try.  

Is there a particular brand that is preferred?
=
Unfortunately it seems that which multifocal is best differs for each person. If you have a brand of contacts that work well for you know, there is a good chance they have a multifocal version of the lens you could try. In my case I used to wear Acuvue Oaysys single vision contacts, so I tried their multifocal first, but wound up liking the Air Optix more.  

Just as with different IOL brands, the optical design of different multifocal contact lenses varies, and each kind often has variants with  different add values. I hadn't checked since then, but there were articles and information on the manufacturers web sites talking about the designs a little bit, in terms of things like whether distance was at the center or near was, etc. However unfortunately at the time there didn't seem to be much if any concrete study comparison data out there giving results for  different models.

I'm guessing there is more concern over doing studies comparing IOLs because they are intended to be permanent so making a good choice is more important. However given the number of people who either wear multifocal contacts, or could benefit from wearing them, it seems a shame they don't do more  studies.  Perhaps they have by now, I just hadn't checked recently.
I took a quick check out of curiosity for multifocal contact studies and there do seem to be some studies out there, though there may not be much difference between the brands. At least one study suggests subjectively the biofinity may be preferred more often. These are just some of the first ones I ran into and may not be the best, I'm not curious enough to look further or evaluate them (or to look to  find free versions of paywalled papers)

http://www.escrs.org/london2014/programme/posters-details.asp?id=21245

http://onlinelibrary.wiley.com/doi/10.1111/cxo.12299/abstract

https://core.ac.uk/download/pdf/42139235.pdf

http://eprints.aston.ac.uk/28397/1/Predicting_success_with_multifocal_contact_lenses_CLAE_2016_PURE.pdf


https://www.ncbi.nlm.nih.gov/pubmed/26704141

Thanks for the info-  I will check out a few brands and let everyone.  It could be some time as I still have a supply of single vision lenses to go through.
=
177275 tn?1511755244
yes thanks for the information and best of luck
Helpful - 1
Avatar universal
I just returned from a post op follow up visit with my surgeon.   It looks like vision has stabilized in both lenses, but if anything changes I will certainly post .

Once again I have Bausch & Lomb Akreos in my left eye and a Tecnis Symfony in my Right eye.

Overall I'm very happy with both lenses.  Even with one eye  implanted with symfony  I can read without issue.  I've only used reading glasses once in the last few weeks and that was in a very dimly lit room reading small grey print against a green background.  

My assessment so far:

Distance vision: 
Very pleased with the results as both eyes measure 20/15.   However, the Akreos eye appears to see far distant objects more clearly and the doctor thinks it's because of the better contrast sensitivity of that lens.    Words on distant street signs for example, are clear in both eyes, but the letters tend to "pop" more with the Akreos eye

Contrast Sensitivity: 
Akreos is excellent and  symfony is very, very good.   Viewing color spectrum charts on my HD screen, both are very similar but akreos sees just slightly more distinction on the lower end of the spectrum.  In real world viewing, akreas sees distinction between greys and browns better when looking at trees and brush in the distance.   Normal everyday viewing there really are no discernible differences.  I'm actually going out of my way to determine differences and with both eyes open and images combined- vision is excellent.  

Glare/Halos:   
No Issues with Akreos.  Symfony lens is still a distraction at night under certain conditions but it's slowly improving as weeks go by and in some situations not a distraction at all when it previously had been.  

Colors: 
Both eyes see colors exactly the same.  Originally the akreos  eye saw blue slightly lighter in color, but now they are both the same.  Very pleased with the rich, vibrant colors both these lenses allow me to see.

Dark room conditions:
By dark room I'm talking about a room with no lights on at night with perhaps only external moonlight shining through a window or ambient light from an adjacent room.      The  Akreos eye sees better under these conditions.  I suspect this is a result of the improved contrast sensitivity.   The symfony eye tends to wash out objects especially on the periphery where akreos can see things like edges of furniture or clothes hanging in a closet a bit more clearly.

Night Driving:
I've driven under multiple conditions at night and aside from the aforementioned halo/haze with symfony, both eyes perform very well under these conditions with akreos more closely approximating my natural lens.  




Helpful - 0
5 Comments
thank you for sharing your valuable observations.
You don't mention what the prescription/refraction is for the two eyes, since distance for the two may vary if say one is at 0D and the other at -0.5D, so it may be comparing apples to oranges, and would need to be done wearing correction to even them out.  Also people's eyes do vary as I mentioned, I have the same model IOL in both eyes, but even with correction the quality of their vision at different distance varies.

That said, I'm still curious if you notice any difference in terms of disability glare bright lights at night, though you'd have to try it from a sidewalk or something since you don't want to be closing an eye while driving at night :-). I think dazzle  disability glare is the phrase used to describe it, where the bright light blinding you and making it harder to see objects in the visual field near the light.  I'd been surprised to see a difference with the Symfony in terms of how much less headlights distracted me compared what I could ever recall before, but I don't know if that is from the Symfony, having any IOL, or peculiar to my case, since I hadn't seen a study of the issue.

Again it is tricky to compare eyes since the same person may have eyes with slightly different characteristics, so it'd still be only one more data point.
=
I wanted to provide a brief update as it may be useful to clarify an earlier post.

Last month I mentioned my Akreos eye seemed clearer than my Symfony eye even though both measured better than 20/20.  I remember when I first got my symfony eye done everything was crystal clear compared to my contact lens eye.  Even far distant objects like street signs or highway overpass signs were very crisp.      A few months later when the Akreos was implanted in my 2nd eye that one seemed clearer.   I thought it was the result of the lens technology, but that may not be the case.  

I just returned from my eye doctor and he said the symfony eye has very slight posterior capsule opacity (aka secondary cataract).  It's not enough to impact my distance scores as they are still 20/20 on an eye chart,  but enough where far distant objects have a bit of a 'softness' around edges.  

It's not cloudy enough to warrant treatment with a YAG, but something to monitor.  

Thank you for the information
Avatar universal
Had my 2nd eye done a couple of days back with an B&L Akreos lens.    To Recap: I used symfony in my dominant eye and akreos in my non-dominant.   I decided to go with the Akreos for the 2nd eye because of distracting halos and glare with the symfony at night.   There was a chance I could have neuro-adapted with a 2nd symfony, but I was unwilling to take that chance because I do a good deal of night driving.

My observations so far between the two lenses:

Distance vision:
Akreos is sharper than Symfony.  No question about it.  Symfony is very good and compared to my good eye wearing a contact lens it was better than that, but now that I have both eyes using an IOL, and can compare side by side- the Akreos exceeds symfony for clarity in distance vision.

Intermediate/Near:
Symfony is much better.  Near vision is very blurry with Akreos as I expected since it's monofocal set for distance.    My tv (about 12 feet away from me) is clear with both eyes.  The news ticker on the bottom of the screen is readable with both lenses, though slightly clearer with my symfony.   My initial concern with choosing monofocal was that anything within 20 feet would be blurry.  For me that is not the case.  Some real world examples.   There is a can of Pepsi on the table across from me about 10 feet away.  The symfony eye can read 'pepsi' very clearly.   The akreos also can read it though it's ever so slightly blurry.  A golf ball at my feet (I'm 6'4" BTW) -  the symfony eye can read the Callaway print without issue, and the akreos sees it as blurry (but can still read it), and the ball itself is fine.    Both eyes open the ball looks fine and the images blend perfectly.

Contrast Sensitivity:
Akreos is excellent and noticeably better than symfony.   The symfony took several weeks for contrast sensitivity to improve to where it is now and was always a bit less than my natural eye.  The akreos- 2 days in - is very similar to my natural lens.

Glare/Halos:  
No Issues with Akreos.  Much better than symfony with headlights and street lamps at night.  

Colors:
Both eyes see colors the same with the exception of blue.   The akreos eye see blue slightly lighter in color.  Very pleased with both lenses in this regard

My opinion:
If you don't mind wearing reading glasses get the akreos.
It's typically covered fully by insurance and  it provides (at least to me) overall sharper vision with improved contrast sensitivity and no night time halos/glare.  The symfony is very good too in terms of distance, but akreos is sharper.

If you want to avoid glasses and don't mind the $2500 per lens, I would suggest getting a symfony in at least your dominant eye.  You will be able to see distance very well to excellent, and have the added benefit of intermediate and near vision being quite good.    However,  I would wait at least a month before getting the 2nd eye done to make sure you don't have issues with halos or glare at night as I did.  If you don't have any issues, and cost is not a concern,  then having two symfony lenses working together will make it much easier to read smaller print.  If I didn't have the glare issues at night while driving I would have gladly gone with another symfony - even if it meant a slight sacrifice in distance clarity and contrast sensitivity.  

If you do have issues with glare/halos then get the non-dominant eye as  a monofocal.   That is my current setup and i'm able to see perfectly for distance.   My car's dashboard and gps screen/backup camera screen is very clear through my symfony eye  and I'm able to read my phone and computer screen without reading glasses.    Although I have not experienced eye fatigue, my doctor said with my current setup.long periods of reading may require reading glasses to avoid fatigue .    I'm at a computer 6+ hours a day and so far so good reading without glasses.

Good luck to everyone considering these decisions as it's not easy as there is no one size fits all.  Best advice is find a doctor who does a good number of these procedures across a diverse population of patients.   My doctor was fantastic and explained all the risks and benefits to all options.  

Thanks also to Dr. Hagan and SoftwarDeveloper for all their contributions.   It's great to have a community where so many can contribute and provide technical expertise as well as real world results.  


Helpful - 0
9 Comments
Glad things went well. Thanks for posting these experiences always are very informative and useful. I like Callaway golf balls also. How much better do you putt and how many strokes per round have you shed?
If only there was an operation to fix my short game.  Now that is something I'd pay out of pocket for !
Of course you may still neuroadapt to get rid of the halos with the Symfony. I forget if I noted on this page, but I've recently noticed a bit over 2 years postop that the halos are gone from some lights where I always saw them before, and even milder around others where I still do see them.

I have one question I'd be curious about, since you seem to be very observant regarding the details of how things appear. One counterbalancing factor for me was that I noticed far less  disability glare with the Symfony than I recalled ever having in the past even before the cataract. i.e. a bright headlight is less distracting and doesn't  wash out as much of the surrounding visual field with its brightness. I haven't been sure if that would have been the  case with any IOL, or any diffractive IOL, or  if its unique to the Symfony, or to just to my case with the Symfony. I think I neglected to raise the issue before you had the 2nd eye done, but I'd be curious if you notice a difference between the two IOLs

In terms of distance vision, do you know the refraction in both eyes? It may be comparing apples to oranges if you are comparing eyes with 2 different refractive errors and trying to compare the absolute quality of distance vision. It may well be that the monofocal is better, but from one data point its not clear. Some studies with the Symfony showed a tie within the margin of error with the monofocal control, though at  least one showed the Symfony with a slight edge (due to its chromatic aberration correction), and some with the monofocal with a slight edge. So overall one presentation I saw suggested expecting likely 20/17 with an aspheric monofocal, 20/18 with the Symfony, 20/20 with a spheric monofocal (rarely used) and 20/22 with a multifocal (though I imagine that varies quite a bit with the particular model).

I will note (I forget if I mentioned this caveat above) that even with the same individual that their eyes can differ. Even before cataracts one of my eyes had a bit better best corrected distance vision. Although I hadn't checked on best corrected vision now with the Symfony I can do a subjective comparison since I did get a pair of photochromic  sunglasses that are clear indoors.  Subjectively without doing actual testing of it, my better eye seems still better now, even with the same IOL in both eyes.

Although I don't need prescription sunglasses since the prescription is so trivial, and I'm at least 20/15 without it, I was just curious if I'd notice the difference (just a little).   I have a pair of non-prescription Tifosi  sports sunglasses that are photochromic that I like, so I decided to go for the same for everyday wear since my old sunglasses are a bit dark.

Also of course, the range of vision people get with the Symfony or a monofocal will vary with each person, so they shouldn't expect the same result as either of us get even with the same refraction. It may be you have a larger depth of focus than average.


It may be you adapted faster to a 2nd IOL in terms of contrast sensitivity after having already gotten one. I suspect that may also vary between eyes, though I don't know how noticeably.

The color issue is odd, the graphs of % light transmission vs. wavelength for each lens looks almost the same, but like perhaps a slight bit less blue light for a little bit of the spectrum from an informal inspection of the graphs, actual data would be needed to be sure. The Akreos info is here (I assume this is the IOL):

http://www.precisionlens.net/Websites/precisionlens/images/B_L_Akreos_AO60P_DFU.pdf

and the Symfony here:

http://www.tecnisiol.eu/tecnis-symfony-iol/files/symfony-dfu.pdf
oops, deleted something by accident. I implied but didn't state meant the photochromic sunglasses I got  are prescription. The result is that subjectively one eye does seem to have better corrected distance vision than the other, but I hadn't tested it to see what an eye chart test would show, I've neglected to ask about best corrected vision at exams. I discovered I could get a cheap pair online even even cheaper  than the non-prescription photochromic sport sunglasses I have, so I figured I'd give it a try out of curiosity.
oops, also prescriptions are  only  done in steps of 0.25D, so that may also be at play in terms of noticing a difference between my eyes even with "corrected" vision.
Also FYI, I know you had a general heading labeled "glare/halos", but some people seem to subjectively use the word glare to refer to something like a halo. I think disability glare is the right phrase for what I'm referring to, though it may be used more narrowly than the general phenomenon I'm referring to of the light being less distracting and not interfering with the visual perception of surrounding things as much.
Both of my eyes had the same refractive error- relatively low at -2.00 for my contacts.

regarding colors- checked my notes from my symfony and noted blues and greens looked lighter than my other eye- so perhaps this is a normal early effect of an IOL implantation and over time the colors will get deeper.

I don't  remember if bright headlights were more or less disturbing with my clear eye vs. symfony.  I'll check between the symfony and akreos at some point.

Just came back from my MD.  He said both eyes are 20/20- they didn't check if they were better than that.   I told him about the improved vision in the akreos over the symfony. He said he would have expected that, but the symfony is still very good.   I asked about its use and he said more and more people are choosing symfony and he's actually surprised how few complain about halos/haze around lights- something commonly reported around other multi-focals.   I think he gave a number in the 30+% range.   He said several multi-focal patients demanded explantations and replacement with standard iol as they couldn't take the issues.   So symfony it appears has corrected a good number of issues generally associated with traditional multifocals.  

He again said he would not be surprised if the issues i'm seeing improved as time went on, but for whatever reason younger patients tend to notice it more or neuroadapt more slowly.  I do notice on some occasions the haze and spiderwebbing around lights are either diminished or just not bothersome.    If it continues to improve- that would be great, but if not that's fine as the combination right now seems to work very well.    

As for distance clarity- symfony is indeed very good and better than my clear eye was with a contact lens.   If both eyes had that lens I would be very satisfied- it's just when comparing the two IOLs side by side i can notice a difference.  It's like buying an HDTV.  In the store when looking at two tvs right next to each other both have a great picture, but one may look a slight bit better.   Even if you took the lesser of the two home, it would look great when viewed alone in your living room.  

So I don't regret the symfony in any way.  In fact I would recommend this setup for anyone looking to get benefits of near vision & distance vision while not having to pay for two premium lenses.  Just one symfony has allowed me to discard reading glasses 99% of the time.  Being in my dominant eye I believe offers additional advantages as well.   This combination is like an advanced monovision.   I can see close, intermediate and far, but don't sacrifice quality on the distance vision.    I'm 20/20 based on the eye charts and possible even better in my akreos eye.  If someone told me a year ago I'd have at least 20/20 in both eyes AND can read anything from newspapers to computer screens to iPhones without glasses - I'd have gladly accepted that outcome - even if I'd have to sacrifice a very small amount of contrast sensitivity in the symfony eye.   When both eyes are open-   which I plan to do 100% of waking hours :-)   the combined images are perfect.  

BTW- there's one more driving scenario that I need to test out: driving on a dark country road without over head street lamps.  In those scenarios the symfony performed exceptionally well.  
re: "Both of my eyes had the same refractive error- relatively low at -2.00 for my contacts. "

The issue is what is the refractive error *now*. If one eye is at 0D and another at -0.5D or  -0.25D then comparing their uncorrected distance vision is an apples to oranges comparison. Even if the targeted 0D for both, that doesn't mean they wound up at that. One of my eyes is at least 20/15 for distance , but its at -0.25D sph -0.25 X 127 cylinder, suggesting it could have been even more myopic and still been 20/20, so its not clear what your refraction is in each eye,  being 20/20 doesn't mean its on target at 0D (in fact if its not better than 20/20, there are decent odds its not).. The apples to apples comparision is with both corrected to 0D for distance.

re: "but for whatever reason younger patients tend to notice it more or neuroadapt more slowly."

I had wondered about that, but hadn't seen any data. I had been curious if younger patients have more sensitive retinas and therefore are more sensitive to the scattered light that is the cause of the halos with the Symfony (scattering off the diffractive rings), since it doesn't have the other issue that actual multifocals do (light from other focal points). For other things, the presumption seems to be that younger patients neuroadapt faster, their brains are more plastic still.


re: "I think he gave a number in the 30+% range.   "

It depends on what you mean by that, whether they see halos at all, or whether they view them as a problem. Most people who see them at all don't consider them a problem. This article going over the data from a few studies noted:

http://www.healio.com/ophthalmology/refractive-surgery/news/print/ocular-surgery-news/%7B02f433be-622c-4611-94b5-77900b429e20%7D/high-rates-of-spectacle-independence-patient-satisfaction-seen-with-symfony-iol
"Most subjects who reported symptoms rated them as mild or moderate. In the U.S. study, for example, reports of severe visual symptoms were less than 2.8% for halos, none for glare and less than 1.5% for starbursts.

Historically, we have seen that 3% to 5% of patients implanted with monofocal aspheric lenses report glare and halo, so there is only a small increase in these studies. It is important to note that the use of femtosecond laser, manual limbal relaxing incisions, and LASIK or PRK enhancement were all disallowed during the study, so residual sphere or cylinder error may also have contributed to the incidence of visual symptoms."

=
Avatar universal
It's been just under 3 months since i had a symfony put in my right eye.  My left eye does not have a cataract and I wear a contact lens -2.0

My assessment so far:

1. distance vision is 20/20 or slightly better
2. reading vision (about 12 inches) 20/30
3. intermediate vision (about 18 inches+) is excellent.  
4. no issues reading my phone, menus, newspaper, computer with one symfony lens and the other nearsighted eye corrected with a -2.00 contact lens.

Issues:
1. only one - night driving I see a fair amount of haze/starbursts around headlights of oncoming cars in certain driving conditions

My options for my 2nd eye are another symfony or a aspheric monofocal.

I just returned from a pre-surgical appointment for my 2nd eye.  The doctor said there's a chance (actually a good chance) the 2nd eye would not have those visual artifacts and be perfectly fine with another symfony.  He also stated neuroadaptation won't start until both eyes are corrected so even though it's been 3 months, the clear eye has not allowed my brain to adapt.   That said - he thought a monofocal would be the least risky for me since I do drive a good deal at night.  The 'worst' part of this decision, he said, is that I wouldn't have the benefit of two eyes using the symfony for near/intermediate vision and then may require readers in some situations.    At this time even with just one eye using a symfony I don't require readers.  I believe in the last 3 months I used them 2 or 3 times to read very tiny print in dim lighting.

The good news for others considering symfony-  In the last 4 or 5 months the majority of his patients choosing multi-focals have gone with symfony and so far I'm the only one to report an issue with halos/glare.    He did qualify that by saying that younger people tend to notice and be bothered by visual artifacts much more than older people, but most eventually adapt after 6 months.

In a few weeks I'll have the monofocal lens implanted and will report back how the vision quality is with this particular combination.  
Helpful - 0
8 Comments
I'm assuming you don't need to decide until the week of surgery which lens to get, so you can see if your night vision improves. Although it hasn't been enough of a concern to bother with  laser correction yet (expending funds & recovery time), I do sometimes notice that my left eye has less near than my right due to being +0.5D in that eye which cuts out half the benefit of the Symfony. I suspect it'd be more of an issue if I had a monofocal in that eye, especially in terms of the 3D perception of near objects.  If you do get a monofocal in that eye, you might consider a bit of micro-monovision with it, which shouldn't reduce distance vision much.

With micro-monovision the distance vision would presumably  about the same as the charts on the manufacturer's site regarding how much micro-monovision with the Symfony reduces distance vision, since the vision out farther than the best focal point is about the same for the Symfony as for a monofocal. Its the range inwards from the best focal point where the Symfony gives a larger range.  

Did you ever try multifocal contacts for the unoperated eye? I'd be curious if you do, if at the same time you try one for the Symfony eye to see if it works at all to expand the range even further. Someone was asking about that on another page. I'd wondered about that myself even before surgery.  I'm curious, but I have a GPC bump under my eyelid from just before surgery that hasn't gone away so I hadn't been ready to put a contact lens in that eye, I should just try it in the other eye at least out of curiosity, but I wouldn't bother until my next eye exam next year.
Oops, I meant I suspect it'd likely be more noticeable if I had a monofocal in one eye even on target at 0D (vs. the Symfony at +0.5D), given I do occasionally notice the issue as it is with this level of difference in near.
I never had the chance to try a multi focal contact with the symfony.  I suspect it would make my close and intermediate better at the expense of distance.  That is what happened when I tried multifocal contacts in the past.  As for mono or micro mono vision. I'd rather not take that chance.  I'd prefer a very crisp distance vision even if reading may not be perfect.

All in all I can't emphasize enough how good this lens is outside during the day or in the office.  At work I can read my computer monitor without glasses 18 inches away or read software sequence and other uml diagrams  projected on a screen 20-25 feet away in a large conference room.  Several coworkers have chuckled when they see me cover one eye to compare to the other - the symfony always is clearer.

   I have clarity and depth perception that I don't remember having since college- before I needed corrective lenses.   I've participated in some sports over the last couple of months and the experience is much improved.   The symfony eye is in my dominant eye so having the intermediate and distance working well in that eye I'm sure is a much greater benefit.

I do have a few weeks before surgery and if my symfony eye improves in terms of night vision I will absolutely go with it in my other eye.  
=
One idea for a contact lens trial came to mind to get some idea of the limitations of a monofocal set for distance.   The FDA clinical trial data for the Symfony gives the data for its monofocal control as well. Since your unoperated eye eye has limited accommodating ability, you could try getting a contact lens set to leave you slightly hyperopic so that it mimics the average reported vision, if an optometrist would trial the lenses to do so.

The data:

http://www.accessdata.fda.gov/cdrh_docs/pdf/P980040S065B.pdf

shows that at 40cm the average uncorrected visual acuity with a Tecnis monofocal was logmar 0.459 which a conversion calculator:

http://www.myvisiontest.com/logmar.php

shows is 20/58, while the average distance corrected visual acuity with the monofocal was 0.544 which is 20/70. I'd err towards exploring worst case what it'd be like, having   the optometrist err on the side of being lower quality vision at 40cm rather than higher quality.  Or actually an even worse case might be to add the standard deviation to those in case you were unlucky, which winds up being uncorrected,corrected:0.642 to 0.719 which is 20/88 to 20/105


Its not an exact test since the defocus curve in between distance and that won't be exactly the same, and the level of accommodation may vary during the day, especially if you are using it a lot.
this is interesting- If I understand you correctly I could probably try this now as I'm currently prescribed a lens with a power of -2.0.  My wife uses  -2.25 lens with a BC and DIA that are exactly the same as mine.   I  can try one of her lenses to see a worst case scenario for near/intermediate vision.  

My doctor said my actual vision in that eye is somewhere between a -1.75 and a -2.00, but we went with a -2.00 contact lens.  I'm hoping my relatively  lower level of myopia in that eye will improve the results typically experienced for intermediate vision using a monofocal IOL.  

My doc was confident my near and intermediate vision would not be worse with the monofocal than it is with my current contact lens.  He said if anything it could be slightly better and my perception of colors will be improved since my natural lens, although clear, is still 50 years old.  

BTW, the doctor chose the B&L Akreos.  He said he's had very good results with that on the monofocal side and is his monofocal lens of choice for his practice.  .  
Her lens is only a +.25 diopter difference, so its doubtful it'd make you hyperopic enough to simulate that level of loss of near.  There are near vision charts on the net to see, here is one you can print out:

http://www.komar.org/faq/colorado-cataract-surgery-crystalens/eye-chart-near-intermediate.pdf

(which I keep meaning to do, but I don't have a working printer, I dislike using paper).

Yup, the perception of colors will change due to the added blue light. The instructions for use of the Symfony:

http://www.tecnisiol.eu/tecnis-symfony-iol/files/symfony-dfu.pdf

includes only one graph (you'l likely have to resize the page to read it) which compares the % light transmission of the Symfony for different wavelengths of light compared to an average 53 year old natural lens and you can see that for instance with some in the violet range its less than half the light get through, and less than 75% through the blue range, while the Symfony lets close to 100% through.

If this is the model of Akreos, then it shows a similar transmission  % (they don't compare it to a phakic eye):

http://www.precisionlens.net/Websites/precisionlens/images/B_L_Akreos_AO60P_DFU.pdf

=
Avatar universal
While you still have your natural lens in one eye, here is one issue I'd been curious about that I thought I'd mention in case you were curious to compare  your eyes.

I'd been curious before about the issue that the Symfony corrects chromatic aberration compared to what the brain has been used to with the natural visual system. Chromatic aberration leads different wavelengths to require different lens powers to be in best focus, so I wasn't sure if there were any subtle depth perception cues this would throw off, but I hadn't noticed any. Since objects vary in color it makes sense that we wouldn't usually rely on it, but I wasn't sure if it'd alter our perceptions a bit still. I finally happened to lookup the term for the phenomenon I was curious about and found a wikipedia overview:

https://www.wikiwand.com/en/Chromostereopsis
"Chromostereopsis
Chromostereopsis is a visual illusion whereby the impression of depth is conveyed in two-dimensional color images, usually of red-blue or red-green colors, but can also be perceived with red-grey or blue-grey images.[1][2] Such illusions have been reported for over a century and have generally been attributed to some form of chromatic aberration."

The Symfony doesn't eliminate all chromatic aberration so I do see a difference in the sample  images on that page (I hadn't searched for any better links on the topic or test images) though I don't know if it would differ from what I'd see without it.
Helpful - 0
2 Comments
=
I'm not sure how I can reliably test this.    My uncorrected eye even with a  contact lense is not perfect.  

I do notice on bright sunny days the exit signs on a highway 1/4 - 1/3 of a mile a way are more distinct with my symfony eye.  Appearing like an enhanced 3D - if that makes any sense.  The edges of the sign are crisp separating it from the background
Avatar universal
Your input is invaluable regarding visual aberrations with the Symfony IOL. My cataract surgery for eye #1 is currently scheduled for 4/5 - one day ahead of your surgery for your second eye.
Helpful - 0
5 Comments
Phaco - I'll be able to provide more info in the third week of March.  I will have my pre-surgical appointment at that time and will relay what he recommends. I'll also see where my vision is at that point and certainly let you know if it continues to improve or stabilizes.    

Last night for example my neighbor's LED house lights beside his front doors appeared to cast a fainter halo than I've noticed previously.   I'm also noticing the very distinct concentric circles that I used to see now have breaks in the circle on some types of lights.  

The link below provides a very good example of what some people see and what they typically looked like to me:
https://intraocularlensexperience.files.wordpress.com/2015/07/dt-symfony-and-restore-combined.jpg
  
Now imagine that same image where between 1&3, 5&7 and 9&11 o'clock it is clear and do not have visible rings.   That's what I've been seeing more recently and the reason I have hope it will continue to improve.  

It's funny, but I was also scheduled to have them both done two weeks apart as well, but cancelled to further assess my risk for RD.   At the two week point I wasn't really concerned about the halos as they were noticeably improving each day.  However, the longer I had the one symfony eye to compare to the clear eye did I then tend to focus on it.    I suspect if I had them both done as scheduled I would have certainly noticed it, but it wouldn't have been too detrimental.    The good news is that most people don't have halo issues at all with symfony and the ones that do only a small percentage of them says it affects their driving at night.
Thanks for the halo drawing link. I'll note though that the image you linked to was the combined image some sees with a Restor in one eye and a Symfony in the other.  I checked the website that image link was from, and its in a post where the author gives 3 artist renderings: one for the halos each eye sees separately and then the combined one you linked to. The page is here:

https://intraocularlensexperience.wordpress.com/2015/07/08/all-done/

What is weird though is his description of 20+ fine circles. The Symfony only has 9 diffraction rings. Oddly I never bothered counting the rings I've seen in halos, but it seems like its somewhere around that (with outer ones being dimmer), I'll try to remember to count.
=
Softwaredev- you are correct- I linked to the wrong picture. However it still gives an idea of what I see but just with less rings.  I actually see 8 rings.

Btw  I have two houses across the street from me each with front porch lights.  One set of lights produces the rings the other something more like subtle starbursts.   I  verified the lights on my neighbor's house that shows more distinct rings are CFL.  The other house I suspect has incandescents.  The  LED lights on my garage do not show rings or the subtle starbursts but instead they show a softer more translucent haze that doesn't extend far from the center of the light.    This is very encouraging as more lights are moving towards LED.  On the flip side, perhaps the light type is inconsequential as car tail lights produce no artifact but break lights (a brighter version of the same light)  produce the rings. Green traffic lights don't but red do.   It's all very interesting.

One other point - I covered my clear eye and looked directly  at the cfl light for about 5- 10 seconds with my symfony eye. The longer I looked the rings appeared to fade away.  Never completely disappearing but certainly less noticeable.  Don't know if this could be considered a form of neuro adaption, but it leads me to believe Its possible to see less of these artifacts over time.  
The artifacts  decrease over time for many people, though I haven't seen any data as to how long it takes with the Symfony on average. Of course even that would just be averages, I seem to be having some adaptation still after what is likely an atypically long time.  As I've noted, in the last month or so  I've noticed the halos being gone (or almost gone) from some lights that consistently gave halos before, though still present for others, and thats at 2 years postop.  I hadn't explored the issue in as much detail as you have in terms of the variation.

I did recently see some stats for halos with a trifocal, merely on the perception of halos (presumably only a fraction of those who perceive them consider them a problem):

https://www.hindawi.com/journals/joph/2015/962891/
"Regarding the perception of photic phenomena, 90% of patients reported to perceive halos at 1 month after surgery, although 80% of these patients described these halos as not disturbing. At 3 months after surgery, the perception of halos decreased to 50%. ...

This perception of halos decreased in all patients at 3 months after surgery. Law et al. [5] also found a reduction in the perception of halos over time, decreasing from 80% at 1 month to 40% at 6 months after the implantation of the same trifocal IOL."

Avatar universal
Hello Petey212:

It would appear that at 7 weeks post-op you are concerned about visual aberrations ("halos/glare")
induced by your Symfony eye. Moreover you are "still considering another Symfony, [or] a monofocal" IOL in your clear, second eye.

I just wondered if the neuro-adaptation concept that SoftwareDeveloper discussed is enhanced by bilateral Symfony IOLs versus the combination of one Symfony IOL and one monofocal IOL, or versus the combination of one Symfony IOL and a contact lens for the clear eye (your present situation).

In the latter case, I could only get some hints with my cataract surgery tentatively set in April with eye #1 to receive a Symfony IOL  - followed two weeks later - by eye #2 also receiving a Symfony IOL. During that two-week interval, I will continue to wear a contact lens in eye #2. Perhaps adjustment to halos would more optimal if I had surgeries with Symfony IOLs in both eyes within ~24 hours, as did SoftwareDeveloper.
Helpful - 0
1 Comments
Hello Phaco101,

At this point if I close my non corrected eye at night the symfony sees very clearly the halos/flares around most lights- LEDs being the most obvious.  When I open my non-symfony eye and both are working together the visual artifacts go away nearly completely.  So there is an immediate neuro-adaption happening - no question about that.  The question I face is will two symfonys neuro-adapt as well as 1 symfony & 1 monofocal.    

I drive a lot at night in various settings- from country roads to the heart of New York City and have compared my clear eye to my symfony.  Dark country roads with limited traffic or limited overhead lights where just my headlights are illuminating the road- the symfony is fantastic.  When I drive at night in Manhattan- the city is so well lit, that it's similar to driving at dusk and also  not an issue.   The problem only occurs on highways and secondary roads with multiple lanes of traffic where you can see headlights of oncoming cars. The headlights cast a halo/haze that fans out about 15 feet from the center of the headlight when the car is in the distance.  As the light gets closer it gets smaller until it disappears completely.  If there are enough cars during nighttime rush hour all the headlights cast this haze that gives the impression of a slight fog or mist on the other side of the road.  

When I first mentioned the halos to my doctor about 2 weeks post-op he said they would slowly improve (which they have) and that having two symfony (or two of any brand multifocal) lenses would definitely assist the neuro-adaption process.   However he could not guarantee the glare/haze would be cancelled out enough to not be visible at all.  

He also said having two symfonys would greatly improve the quality of my near/intermediate vision- which as stated- has been good enough from day 1 post-op for me to read without reading glasses with just one eye done. So that even greater improvement is weighing heavily in my decision as well.

Although I am still considering a standard lens in my other eye, I have some concerns with that approach as well since I've heard some people also experience halos with standard lenses.  Perhaps some people are just predisposed to halos based on the geometry of their eyes.   My concern is if  I go with a standard lens and still have halos I don't solve the problem and I lose the near and intermediate benefits of having two symfonys.  

My next pre-surgical appointment is end of March and surgery on 4/6.  At that point I will be 3 1/2 months post-op.  I'm hoping by that time the halos have subsided enough that I can proceed with the symfony in the other eye without hesitation.    
Avatar universal
7 weeks post - OP update:

Daytime vision is fantastic, but night I still see halos and starburst around lights.  


Last week I followed up with a retina specialist.   He evaluated both eyes to assess the risk of Retinal Detachment.   This was not something my original surgeon suggested,  but a concern of mine before I resumed sports - specifically weight training and before I had my other eye (without a cataract) done.

The retina specialist stated I have a couple of risk factors for RD (including the surgery), but he would consider them minor.  If I had a family history of RD that would have been a much bigger concern.  

He informed me I have slight lattice degeneration which is a risk factor that gives someone a  .5% chance of RD.   He was not concerned about that (as he said it was slight) and said he would see no reason not to move forward with the second surgery.  He did clarify that he would not recommend doing a clear lens exchange on both eyes, but since I had one already done, keeping both eyes in sync is a significant benefit as well as a safety concern.

As far as sports & weight training he said do anything I did before with the exception of boxing or anything that could result in a punch to the eye- basically the advice he'd give anyone - IOL or not.  He said proper breathing during weight training should also be used to reduce unnecessary pressure.  

I have an appointment with my cataract surgeon in three weeks for a pre-surgical evaluation.    At this time I'm still considering another symfony, but also a monofocal (possibly even lasik) in my clear eye. I want good distance vision in both eyes, but I also want to reduce the chance of glare/halo in the second ey.   As stated I do have halos in my symfony eye and I'm concerned if I have it in both it would significantly impact my night driving.  Right now the good eye offsets the haze and concentric circles I see around lights and is not an issue.   If I had it in both- it could be a problem.
Helpful - 0
Avatar universal
Hi Petey212:

Thanks for your detailed experience so far with the Tecnis "Symphony" IOL in one eye. (And thanks as well to SoftwareDeveloper who is a kind of anchor on this forum.)
So far, you describe a very encouraging post-op experience!

I am now preparing for bilateral cataract surgery in April, and I wondered if the optical performance of your Symphony eye is still stable, and if your visual disturbances continue to recede?
Helpful - 0
9 Comments
Why did some word software auto-correct Symfony to Symphony?
=
The musical composition for an orchestra called a symphony in English is  spelled symphony. So the real  question is why they spelled the IOL name Symfony instead of using the default spelling. Perhaps  they  wanted a different spelling since they were merely making an analogy to a symphony and thought since its not actually a musical composition they should spell it differently.  Perhaps it was so they could trademark it, or    I don't know if some other language has the same word and spells it that way and they liked the look of it.

Perhaps they wished to make it easier for people to find the lens in a search engine if they used a different spelling than the common word. However there is  a programming framework also called Symfony, but  you get the right hits for the lens by also including the word  IOL or Tecnis or some other relevant word in the search. If they'd named it Symphony the same tactic of adding a word  would also have worked to limit search hits. That suggests other factors are   more likely than search engine issues.
=
I suspect a neologism for trademark purposes but have a pleasing "root"  very common in naming medications.
hello phaco101- sorry for the long delay in responding.   For some reason I don't get notifications when someone comments on my posts.

At this time i'm about 6 weeks post op with just one eye repaired. Overall I'm very, very happy with the results and it's been interesting to compare a symfony repaired eye to a clear eye with a contact lens.  

Although both eyes measure 20/20 on an eye chart, the symfony eye is MUCH brighter and sharper during daylight and dusk.  At night the vision is also clear, but there are halos (especially when a driver presses their brakes- the brake lights tend to throw more halo than regular tail lights).  Headlights of approaching cars also have subtle halos that make the lights appear out of focus.  This is really my only complaint   It has gotten a bit better since the first week or so, but I suspect after the next few weeks whatever anomalies i see will likely remain.   My doctor said with both eyes done the brain could 'filter' out some of that halo noise, but not sure how that would work honestly.


The initial issues with contrast sensitivity have improved.  My office overlooks a wooded area and when I first had the procedure done the non-symfony eye saw the subtle shades, of browns, greens and greys between each tree and branch much more distinctly.  At this point the difference is negligible.

Intermediate vision is perfect. I can read sheet music from 2-3 feet away and  my car's dashboard, odometer, gps- without any issues.  My TV, which is about 12 feet from my couch, is much clearer with the symfony eye.  

Near vision (12-18 inches) is very good.  With even only one eye repaired i'm able to use a computer, ipad, iphone  from about 14-16 inches away without the need for reading glasses.   The only time I needed readers in the last month or so was to read an expiration date on a pill bottle.  I can read menus without issue in proper lighting.  If a restaurant is dimly lit i need my iphone home screen's back light to provide additional illumination. Not the flashlight on the phone, but just the home screen.   Newspapers and books are no issue with proper lighting.  

Very Close (less than 12 inches) my non symfony eye without a contact lens is better.  I don't normally do anything that requires such precise up close vision- so not an issue.  If I do need that level of vision I'll wear readers.

As mentioned only one of my eyes had a cataract so getting the second eye done would be considered a clear lens exchange and somewhat of a luxury.  If the second eye had even a minor cataract I would not hesitate doing it.

Because I'm aware of risks of Retinal Detachment I've been holding off getting the good eye done, but honestly  it would be great to have both working in sync.  I have an appointment later this week with someone who is considered one of the top retinal specialists in NY to assess both my eyes in terms of retinal quality. I'm hoping he can provide a risk assessment of RD occurring based on my eye structure, quality, etc.  Based on that I will determine whether to get the second eye done.  I'm hoping he gives the go ahead!
re: "the brain could 'filter' out some of that halo noise, but not sure how that would work honestly."

The brain is capable of neuroadapting to things we wouldn't think possible. There have been experiments done with people wearing glasses that flipped the world upside down.. and eventually their brains adapted and flipped the world right side up. Google: neuroadaptation upside down

It could be your vision in general will still keep improving slightly for a while. I'd read one surgeon suggest neuroadaptation actually took longer with the Symfony than with the trifocal, but he didn't respond to a request to quantify that vague statement. (and of course it varies by person).

I'm one of the minority that continued  to see halos after the first few months. Oddly in the last month or so, despite being  over 2 years postop, I've started to notice that some lights where i consistently saw halos, they aren't there anymore, though they still are in other places. They've never been a problem  for me (so translucent/mild I see through/ past them), especially since overall night vision is better, bright headlights are less distracting, they cause less glare.

Retinal detachment is a fairly low risk, it used to be far more of a risk with older cataract surgery techniques from a few decades ago which were much more traumatic to the eye. I hadn't checked on the most recent estimates, a few years ago some things I read suggested it was like 1 out of 400 on average, but it may have gone down since then (and  studies are often done based on people who had surgery a  few years old since they are based on the cumulative risk over a few years).

  Unfortunately some of the figures online for the risk of retinal detachment seem to be people copying what they've seen elsewhere, with the original source being out of date studies. You do have the risk factors of being male and young (oddly being < 60 seems to be a risk factor, rather than being older), so I don't know how much more than average your risk would be, but the biggest risk factor seems to be being highly myopic (and at least some work suggests cataract surgery doesn't increase the risk for high myopes, it is merely higher to begin with).

Even with modern small incision phaco cataract surgery the risk of RD roughly doubles after uncomplicated surgery. If there are no risk factors like high myopia,  history of trauma, family history of RD, RE in fellow eye the risk is about 1 in 5000  after cataract surgery uncomplicated its about 1 in 2000. With old time complete removal of the lens (intracapsular) the risk was about 1-3% so you can see how much surgery has changed. The highest risks are highly myopic relatively young males (40-60) where the risk be that high in some cases.
More on incidence of RD. This paper says one in 10,000 (not have had cataract surgery)  https://www.reviewofophthalmology.com/article/prophylaxis-for-retinal-detachment  "Retinal detachment occurs with a frequency of 1/10,000 people per year,1 and patients at risk for RD include those with myopia, aphakia, trauma, RD in the fellow eye, a family history of RD, certain systemic syndromes, and a variety of peripheral retinal lesions. Precursors to RD include posterior vitreous detachment, symptomatic retinal breaks, asymptomatic retinal breaks, lattice degeneration, and other less common vitreoretinal abnormalities. "
Avatar universal
I just had a follow up with doctor.   11 days post op distance vision in corrected eye is 20/20.   He said it may improve a bit more, but intermediate and near is more likely to improve.  Right now I'm very satisfied with intermediate vision which is 20/20 at computer distance.    If near improves even more that would be fantastic.
When I asked about risk for Retinal Detachment in younger men he was not overly concerned.  He said there is a risk factor, but incidents are much lower now than 1980s/early 90s and even better than just 10 - 15 years ago.  My axial length is 26.2 - which he said is longer than average and another risk factor.  He said although it ‘mathematically’ increases risk, realistically it's still very low.    
That said I am going to postpone having the second eye done since at this time it is still 20/20 with a contact lens and unaffected by the very small cataract it has.    He had no issue with that, but said it may  take longer to neuro-adapt to the symfony.  Next appointment is 1 month from now.
My observations so far:
Overall I’m extremely happy with the results.  Being able to see very clearly out of this eye for the first time in several years is just amazing.  I’m able to read sheet music, restaurant menus (with decent light), my iphone, and see the TV  perfectly (about 14 feet from my couch).   Everything from about 15 inches out is remarkably clear.    All that while having excellent distance vision.  
At this point I still see a slight haze around lights at night and depending on the type/color of light - Led, fluorescent, incandescent, etc. the haze is either not there at all,  more prominent or I can sometimes slightly see the symfony’s concentric rings within the haze.    All very subtle and not really distracting, but I can see it.  
The doctor has not done many symfonys but based on reports and other multi-focals, he feels this haze will reduce over time.  I certainly notice it’s getting better each day.   Interesting point- last night while driving in heavy rain the haze around the lights was greatly reduced- almost non-existent.  Perhaps the light passing through the rain droplets somehow diffused the haze to make it unnoticeable. I’ll have to check some of my physics books to determine the optics of that effect.   The wet streets with the reflected street lights & headlights posed no issue at all with glare.    I was expecting driving at night in the rain to be worse, but was pleasantly surprised.   I have also driven in a minor snow storm and it was fine- if anything the symfony was better than the good eye.  
My observations based on different lighting conditions:
Bright Daylight-
No difference between my good eye and symfony.   Both see equally well.  One exception- when looking into a wooded area in the distance the symfony eye tends to blend the subtle browns.  The doctor feels the contrast sensitivity would improve with time and would likely be faster with symfony lenses in both eyes.  
Overcast Days/ Dusk –
    Symfony eye appears brighter and much crisper than my natural lens

Night –
On dark roads vision is excellent, however, to the symfony eye the shoulder or woods to the side of the road in my periphery appear darker.   Freeways and city streets symfony is very good and I can read street signs, license plate, etc. without issue.  Back lit street signs or store signs appear clearer in the symfony eye.  The only issue at night is the aforementioned slight haze around lights

Helpful - 0
4 Comments
=
Wondering if the issue with halos and glare has to do with age of patient.  I am 53 and having cataract surgery soon.   Younger you are pupils dialate more.   Any thoughts on that?
I also have wondered if how much a person's pupil dilates at night may affect the degree of the night vision issues seen with Symfony IOL, especially since some patients have told of their eye doctor prescribing an eye drop medication that constricts the pupil (undialates) to help reduce the halos/glare/starbursts?
=
Avatar universal
You were only a -2D myope, which is considered low myopia and isn't high enough to be considered a noticeable risk factor  for retinal detachment. High myopia is usually considered to be -6D or more.   Axial length long enough to be a risk factors of concern tends to go along with high myopia. Its useful to be aware that retinal detachment is possible, but the risk is fairly low.

FYI, in terms of Symfony results, I'm now 2 years +1 month  postop and just had an eye check this week. I tested at least  20/15 at distance (they didn't show a line below that to see if it might be a bit better than that. I should have asked out of curiosity, that  line was easy to read), and 20/20 at computer distance (plus a bit on the line below).

In the past I consistently tested 20/25 at my best near distance, but in this case they didn't have a line for that. They tested at 40 centimeters (rather than best near) and I was 20/30, though I saw some of the 20/20 line below that.

My near is aided by a very tiny bit of accidental myopia in my right eye that provides most of the near (making up for hyperopia in the other).

OD: -0.25D -0.25D X 127
OS: +0.5D (no astigmatism).

The right eye   sees 20/15 at distance despite that tiny myopia, oddly the left eye can't read the 20/15 line. I neglected to find out what my best corrected distance vision would be, since I did see some improvement with the refraction.

  In the past  my right eye was  0D but with -0.5D of astigmatism, I don't know if it was a very slight shift or its just within the margin of measurement error with   a different doctor doing the refraction using different equipment.  I  keep wondering about a laser teak for the hyperopic eye, but it hasn't been enough of an issue to bother looking into it, and not worth the expense for the moment.
Helpful - 0
10 Comments
=
Softwaredeveloper thanks for your update.  Glad to hear a couple of years out your vision is still very good.  I have to say your detailed posts were very influential in me making the decision to move forward and to select  this lens when it became  available here.

Im glad to hear my level of myopia is lower risk for RD.  I have another meeting with my doctor next week and will discuss more.   I will also ask about my axial length.

One other thing I want to add. I'm in a unique position to compare an eye without a cataract to an eye with a symfony.  Granted my clear eye is 50 years old but it's 20/20 with a contact lens.  It's really amazing how in some (often many) situations symfony is better than my natural lens.  Today while driving at dusk for example my  symfony lens saw the cars and details of the road much better than my other eye with an unclouded natural lens.   In daylight the symfony is like enhanced 3D in that it's very sharp and depth perception is improved.  One place it falls short though  is very dimly lit rooms.  When I walk into a room at night just before I switch on the overhead light to the symfony eye the room appears a shade darker.  

One quick question after a month or so are there any restrictions in terms of activities?  I realize taking up boxing may not be wise at this point in my life but is weight lifting ok after fully healed?
=
Weight lifting will be ok eventually of course, but you'd have to check with your doctor to see what they recommend in terms of how long to wait since I've seen conflicting info on the net (or perhaps someone else will chime in).    I was curious about whether even carrying luggage after surgery would be an issue and I remember  the guidelines about how much weight to lift in the first few days varied quite a bit, I wasn't sure what if any of them were merely guesses, just copied from other sources for decades,  vs. research based.  I don't lift weights (though I know I should to deter loss of muscle mass with age, later this year I expect to get into it, building up running first).

By age 50 even a healthy natural lens has deteriorated some, dysfunctional lens syndrome I've seen it referred to as. There is some reduction for instance in the blue light spectrum in a natural lens compared to what you get with an IOL (ones that aren't blue-blockers). With the Symfony  you  can even  see a little bit into the UV spectrum in wavelengths usually filtered even by a young natural lens but that the retina can still perceive when the IOL lets them through.

It is interesting to see your comparisons between a natural lens and the Symfony, since I need to rely on possibly flawed memories. I had a sense that night vision is better in some ways due to less glare.   I have been curious how much of an impact having a larger range of focus all at once compared to the natural eye (which needs to accommodate to shift focus) had on my impression of having better vision, in addition to the impact of chromatic aberration correction (rather than mere reduction of it).

I wore  multifocal contact lenses for a few years before my cataract surgery issue and that reduced my vision in low light, so in my case low light vision improved to what I'd gotten used to.
Someone I know here in Boulder documented the issue of seeing into the UV spectrum with an IOL, in his case the Crystalens, and his page on it gives some images and graphs showing the impact aging has on the natural lens in general (not just regarding the UV issue):

http://www.komar.org/faq/colorado-cataract-surgery-crystalens/ultra-violet-color-glow/

=
I read his detailed document on his crystalens experience when I considered that lens last summer.  It was very informative.  

While playing golf last year I had a chance pairing with an opthamologist.  I didn't want to bug him with questions so at the end of the round casually asked what he thought of the various lenses.   He said crystalens is a difficult lens to get right and most issues/dissatisfaction that he sees- that are lens related - stem from that lens.  He said personally, if he had cataracts, he would choose a mono focus lens as he had no issue wearing glasses for near tasks. However this was before symfony was available in the US.

Getting back to colors.  The only difference I see is that the sky looks bluer and whites whiter in my symfony eye vs my other eye.  Out of curiosity i viewed online a color spectrum from 780nm to 390nm. The symfony eye saw all the colors just fine but it appeared to soften or blend the colors together. my natural eye was able to see more subtle distinction between consectutive colors.  Some of the colors toward the lower end of the spectrum appeared darker and more prominent with my non-symfony eye.  Even this black text that I'm writing here on this post looks darker with my non symfony eye.

I'm just over a week post op so it will be interesting to see if this changes in the upcoming weeks/months.   For example, my near vision appears to be improving a bit each day as well as some haze around bright lights is fading a bit.  So color detection may change as well.  
=
The eye is used to the level of chromatic aberration of a natural lens, and the Symfony corrects that. So it would make sense that  exact  color detection might possibly take some adaptation time, though without a comparison point of a natural lens it wasn't something that I was aware of. The world just seemed brighter and colors more vibrant, more 3D and crisp, but there was no way to examine the exact difference. Unfortunately it may be that your adaptation time will be slower when you only have one eye with the Symfony rather than both and the brain needs to combine images produced by different sorts of optics.

FYI, I somehow missed this journal article from the summer which claims:

http://www.healio.com/ophthalmology/journals/jrs/2016-7-32-7/%7B46dbd69f-5cd3-4fe4-beed-2c2c1e0fc415%7D/comparative-analysis-of-the-clinical-outcomes-with-a-monofocal-and-an-extended-range-of-vision-intraocular-lens
"The extended range of vision IOL provides better distance, intermediate, and near visual acuity than the aspheric monofocal IOL, while maintaining the same level of visual quality."

I knew the distance vision was at least fairly comparable to a monofocal, I hadn't realized it might actually be better rather than merely close enough most people wouldn't notice the difference. I'd mostly paid attention to studies comparing the Symfony with other premium IOLs, or the issue of halos&glare compared to monofocals, rather than comparing acuity results with monofocals.
=
Have an Answer?

You are reading content posted in the Eye Care Community

Top General Health Answerers
177275 tn?1511755244
Kansas City, MO
Avatar universal
Grand Prairie, TX
Avatar universal
San Diego, CA
Learn About Top Answerers
Didn't find the answer you were looking for?
Ask a question
Popular Resources
Discharge often isn't normal, and could mean an infection or an STD.
In this unique and fascinating report from Missouri Medicine, world-renowned expert Dr. Raymond Moody examines what really happens when we almost die.
Think a loved one may be experiencing hearing loss? Here are five warning signs to watch for.
When it comes to your health, timing is everything
We’ve got a crash course on metabolism basics.
Learn what you can do to avoid ski injury and other common winter sports injury.